title: Improved laboratory resource utilization and patient care with the use of rapid on-site evaluation for endobronchial ultrasound fine-needle aspiration biopsy.
abstract: BACKGROUND
  Endobronchial ultrasound guided (EBUS) fine-needle aspiration (FNA) biopsy has become widely used to evaluate patients with thoracic abnormalities. Rapid on-site evaluation (ROSE) can provide the bronchoscopist with immediate evaluation findings during the procedure. This study examines EBUS FNA biopsy procedures with and without ROSE, and investigates the impact of ROSE service on the EBUS procedure and laboratory resource utilization.
  
  
  METHODS
  The cytopathology database at Washington University Medical Center, St. Louis, Missouri, was searched for EBUS FNA biopsy cases before and after introduction of ROSE service, and a matched cohort was collected. Reports were reviewed and pertinent data was collected, such as sites biopsied, ROSE performance, slide smears, cell blocks, and diagnostic categories. Statistical analysis of the results was performed.
  
  
  RESULTS
  A matched case-controlled EBUS FNA cohort of 340 patients (680 total) for each category of non-ROSE and ROSE service were identified. There was a 33% reduction in the number of sites biopsied with ROSE. A total of 68% of patients with ROSE had just one biopsy site compared to only 36% of non-ROSE patients. There was a 30% decrease in total slides (mean, 5.27 slides) after the introduction of ROSE. All of these improvements were statistically significant.
  
  
  CONCLUSIONS
  EBUS FNA biopsy ROSE service benefits patients by contributing to significantly fewer biopsies and improved utilization of health care resources. ROSE service results in substantially fewer total slides, which has a significant impact on the cytopathology laboratory work effort. The use of ROSE for EBUS FNA biopsy provides significant improvements in patient care and laboratory resource utilization.
authors.affiliation: Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Collins
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Chen
authors.forename: Jeff F
authors.initials: JF
authors.lastname: Wang
authors.forename: Cory T
authors.initials: CT
authors.lastname: Bernadt
authors.forename: Souzan
authors.initials: S
authors.lastname: Sanati
mesh_terms: D001980:Bronchi / Q000000981:diagnostic imaging / Q000473:pathology*; D016022:Case-Control Studies; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007753:Laboratories / Q000706:statistics & numerical data*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D005791:Patient Care; D058996:Quality Improvement
keywords: endobronchial ultrasound; fine-needle aspiration; health care resource utilization; lung cancer; pulmonary; rapid on-site evaluation